EFFECT OF KINESIO TAPING ON ISOKINETIC PARAMETERS OF ANKLE JOINT

Transcription

1 EFFECT OF KINESIO TAPING ON ISOKINETIC PARAMETERS OF ANKLE JOINT Thesis Submitted to the Department of Biomechanics in Partial Fulfillment of the Requirements for the Doctoral Degree in Physical Therapy By Ghada Abdel Moneim Mohamed Aly B.Sc. in Physical Therapy, Cairo University, 1999 M.Sc. in Physical Therapy, Cairo University, 2007 Department of Biomechanics Supervisors Prof. Dr. Salam Mohamed El-Hafez Professor and head of Biomechanics Department of Biomechanics Faculty of Physical Therapy Cairo University Dr. Ahmed Yousry Radwan Lecturer of Biomechanics Department Department of Biomechanics Faculty of Physical Therapy Cairo University Prof. Dr. Nagui Sobhi Nassif Assistant Professor of Biomechanics Department of Biomechanics Faculty of Physical Therapy Cairo University Faculty of Physical Therapy Cairo University 2012

2 Appendix I ١٣٣

3 TABLE OF CONTENTS ACKNOWLEDGEMET ABSTRACT. TABLE OF CONTENT... LIST OF TABLES LIST OF FIGURES.. LIST OF ABBREVIATIONS.. DEFENTION OF TERMS i iii iv vi viii xv xvi CHAPTER I INTRODUCTION Statement of the problem Purposes of the study. 4 - Significance of the study Delimitations Basic assumptions Hypotheses. 6 CHAPTER II LITERATURE REVIEW Ankle anatomy and biomechanics 7 I. Terminology for motions and positions... 8 II. Structure and function of the joints associated with ankle 8 1. Talocrural joint... 8 A. Articular structure. 8 B. Ligaments The subtalar joint A. Articular structure.. 13 B. Ligaments The distal tibiofibular syndesmosis A. Articular structure.. 16 B. Ligaments III. Ankle muscles Ankle sprain Aetiology of lateral ankle sprain injury 23 - Mechanism and biomechanics of lateral ankle sprain injury 24 - Grading systems for evaluating acute ankle ligamentous sprain Sequela of ankle ligamentous sprain Treatment and Prevention of sport-related ankle sprain injury Kinesio tape I. Properties of kinesio tape.. 33 II. Benefits of kinesio tape 34 iv

4 III. Selection of kinesio tape type. 34 IV. Basic application essentials 35 V. Types of kinesio tape VI. Size of kinesio tape. 37 IX. Corrective techniques. 37 X. Kinesio tape concept 40 - Isokinetic dynamometer 55 I. Reciprocal muscle-group ratios. 55 II. Ankle force-velocity relationships Strength deficits in subjects with chronic ankle instability CHAPTER III MATERIALS AND METHODS Subject selection 62 - Instruments Biodex isokinetic dynamometer Height and weight scale Kinesio tape Athletic tape Testing procedures. 67 I. Preparatory phase.. 67 II. Experimental phase Taping techniques Isokinetic set up and positioning Isokinetic testing procedures Data analysis Statistical Design 81 CHAPTER IV RESULTS 82 CHAPTER V DISCUSSION CHAPTER VI SUMMARY AND CONCLUSION Summary Conclusion RECOMMENDATIONS 120 REFERENCES 121 APPENDIX ARABIC SUMMARY.. - v

5 Chapter I Introduction The ankle and foot represent the final component of the lower extremity and function together to make habitual bipedal stance and locomotion. So it must be stable enough to bear the weight of the rest of the body. As a result, the muscles of the leg and foot play an essential role in stabilizing the ankle/foot complex during loadig and also in propelling and controlling the advancement of the body over the foot during locomotion. As the ankle and foot participate in locomotion they sustain very large loads that may contribute to some of the clinical complaints reported by patients (Oatis, 2004). A sprained ankle is one of the most common orthopedic injuries. Ankle sprains occur in both athletes and those with sedentary lifestyles, and they can occur during sports or when walking to carry out daily activities (De Noronha and Junior, 2004). Injuries to the lateral ligamentous complex of the ankle result in more time lost from participation than any other single sportsrelated injury. After an ankle injury, residual symptoms can also affect activities of daily life; about 33% of patients with a lateral ankle sprain have persistent residual symptoms 2 years after the initial injury (Fox et al., 2008). Twenty to forty % of the acute ankle sprains develop into chronic ankle instability if rehabilitation is inadequate. Chronic ankle instability represents a typical sports injury which can mostly be seen in basketball, soccer and other high risk sports (Mckay et al., 2001). Prevention and treatment programs for ankle injuries can be time and costly consuming (Kaminski et al., 1999). In first-time lateral ankle sprains, although both immobilization and early mobilization prevent late residual symptoms and ankle instability, early mobilization allows earlier return to work (54% versus 13%) and may be

6 Introduction more comfortable for patients (Eiff et al., 1994). Prophylactic ankle taping has been considered the mainstay of ankle injury prevention. It has been used at all levels of competitive football (Mickel et al., 2006). Ankle taping protects ankle from excessive range of motion, increase proprioception input, increase peroneal muscle activity, and ankle motion deceleration (Riemann et al., 2002).The most commonly used tape applications are done with non stretch tape. The rationale is to provide protection and support to a joint or a muscle (Alexander et al., 2003). Abian et al. (2009) recommend the use of elastic tape (ET) as the first choice for prophylactic ankle taping. Because it produces the same restriction in the ROM as the inelastic tape (IT) but with less taping fatigue, and is perceived as more comfortable and less restrictive by the users. In recent years, the use of Kinesio Tape (KT) has become increasingly popular. KT was designed to mimic the qualities of human skin. It has roughly the same thickness as the epidermis (Kase et al., 2003). Kinesio tape differs from traditional white athletic tape in the sense that it is elastic and can be stretched to 140% of its original length before being applied to the skin. It subsequently provides a constant pulling (shear) force to the skin over which it is applied unlike traditional white athletic tape. The fabric of this specialized tape is air permeable and water resistant and can be worn for repetitive days. Kinesio tape is currently being used immediately following injury and during the rehabilitation process (Halseth et al., 2004). The proposed mechanisms by which Kinesio tape works are different than those underlying traditional ankle taping. Rather than being structurally supportive, like white athletic tape, Kinesio tape is therapeutic in nature. According to Kenzo Kase, the creator of Kinesio tape, these proposed mechanisms may include: (1) correcting muscle function through a sensorimotor mechanism (2) improving circulation of blood and lymph by eliminating tissue fluid or bleeding beneath the skin by moving the muscle, 2

7 Introduction (3) decreasing pain through neurological suppression, and (4) repositioning subluxed joints by relieving abnormal muscle tension, helping to return the function of fascia and muscle (Kase et al., 2003). A fifth mechanism has been suggested by Murray and Husk (2001) who examined the effect of kinesio taping on ankle proprioception. They concluded that kinesio taping for a lateral ankle sprain improved proprioceptive abilities through increased stimulation to cutaneous mechanoreceptors in non-weight bearing positions in the midrange of ankle motion. Physicians and other clinicians frequently use reciprocal musclegroup ratios in determining return-to-play status and establishing rehabilitation goals. The reciprocal contraction-mode ratios may provide important clinical information, especially in the ankle (Hartsell, 1999). In the ankle region, these ratios are typically expressed as Eversion CON /Inversion ECC (EV CON /INV ECC ) and Eversion ECC/Inversion CON (EV ECC /INV CON ). The more traditional expression of the muscle action-mode ratios is that of EV CON /INV ECC. Perhaps this ratio expresses the traditional viewpoint of the invertors acting eccentrically to slow the lateral displacement of the tibia in a closed kinetic chain. It also gives some credence to the need to examine invertor strength deficits in those with chronic ankle instability (CAI) (Perrin, 1993). The opposite ratio expression involving EV ECC /INV CON has also recently been explored. This more functional expression of the ratio describes how the peroneal muscles may react eccentrically to slow the rate of inversion in an open kinetic chain (Kaminski et al, 2001). A high incidence of inversion ankle sprains occurs in individuals with muscle strength imbalance. There are numerous factors and mechanisms that are thought to prevent increased ankle sprain occurrence. Eccentric evertor muscle strength as well as eccentric evertor/ concentric invertor strength ratio (EV ECC /INV CON ) is one of these factors associated with the prevention of 3

8 Introduction inversion trauma. An increase of this ratio is expected for preventing ankle inversion sprain (Yildiz et al., 2003). Moreover, ankle EV/INV ratios may be more physiologic and functionally sound than measuring strength alone in an attempt to prevent ankle injuries (Hsiu Lin et al., 2008). The popularity of application of kinesio tape during the rehabilitation process, and the need for empirical evidence on the effect of kinesio tape are compelling reasons to perform further researches on KT. There are only two studies which have been reported regarding the effect of kinesio taping on the ankle joint, they pointed out its effect on ankle propriocepion. Neither of the previous researches studied the effect of kinesio taping on the ankle musculature or strength ratios. So, the main aim of this study is to examine the effect of three different taping modes (No tape, Athletic tape and Kinesio tape) on the peak torque and strength ratios of ankle evertors and invertors. Statement of the problem: Will the concentric and eccentric peak torque of ankle evertors and invertors change with different taping modes? Will the strength ratios of ankle evertors and invertors (EV CON /INV ECC and EV ECC /INV CON ) change with different taping modes? Purpose of the study: The purposes of this study are: 1. To examine the effect of different taping modes (No tape, Athletic tape and Kinesio tape) on the concentric and eccentric peak torque of ankle evertors and invertors. 2. To examine the effect of different taping modes (No tape, Athletic tape and Kinesio tape) on the strength ratios of ankle evertors and invertors (EV CON /INV ECC and EV ECC /INV CON ) 4

9 Significance of the study Introduction Although the wide use of kinesio tape in the field of rehabilitation, understanding the mechanism of action of KT is insufficient. This study is hoped to provide knowledge regarding which taping mode will improve the strength and strength ratios of invertors and evertors and consequently provide a good muscle performance. So it may help to eliminate the gap between science and application. KT can correct muscle function, if this concept is being supported by this study,that will confirm the use of ankle kinsio taping in the field of rehabilitation as means of treatment and prevention of ankle injuries. Delimitations This study was delimited to the following: 1- Subjects with normal range of motion of lower extremity. 2- Subjects who never involved in any professional training program. 3. Subjects who never have any previous history of ankle instability, pain, injury or surgery. 4. Measurements of peak torque and strength ratio of ankle invertors and evertors. Basic assumptions It is assumed that 1. All subjects were under normal psycho-physiological condition. 2. All subjects conducted and followed the instructions of the study. 3. Every subject exerted his maximum effort. 4. The level of instrumentation operation was the same through the entire time of testing. 5

10 Hypotheses Introduction The hypotheses of this study are: There is no significant difference in the peak torque of ankle evertors and invertors among the three different taping modes. There is no significant difference in the strength ratios of ankle evertors and invertors among the three different taping modes. 6

11 CHAPTER II Literature Review LITERATURE REVIEW The primary function of the ankle and foot is to absorb shock and impact thrust to the body during walking. While walking and running, the foot must be pliable enough to absorb the impact of millions of contacts throughout a life-time. Pliability also allows the foot to conform to countless spatial configurations between it and the ground. Walking and running also require that the foot be relatively rigid to withstand the large propulsive thrusts created at the push-off phase of walking. The healthy foot satisfies the seemingly paradoxical requirements of both shock absorption and thrust through an interaction of interrelated joints, connective tissues, and muscles (Neumann, 2002). Ankle anatomy and biomechanics: As the ankle and foot participate in locomotion they sustain very large loads that may contribute to some of the clinical complaints reported by patients (Oatis, 2004). The ankle\ foot complex must be stable enough to bear weight of the rest of the body. As a result, the muscles of the leg and foot play an essential role in stabilizing the ankle\ foot complex during loading (Nordin and Frankel, 2001). In human anatomy, the ankle joint is where the foot and the leg segments meet. It comprises of three major articulations: the talocrural joint (mortise), the subtalar joint, and the distal tibiofibular syndesmosis (fig. 2-1) (Hertel, 2000). Figure 2-1. Ankle complex, posterior view, Adopted from Agur and Dalley, (2009). 7

12 I. Terminology for motions and positions: Literature Review The terminology used to describe the movements of the ankle and foot incorporates two sets of definitions: a fundamental set and applied set. The fundamental terminology describes the movement of the foot or ankle that occurs at right angles to the three standard axes of rotation. Dorsiflexion (extension) and planter flexion describe the motion that is parallel to the sagittal plane, around a medial-lateral axis of rotation. Eversion and inversion describes the motion parallel to the frontal plane, around an anterior- posterior axis of rotation. Abduction and adduction describe the motion in the horizontal plane around the vertical (superiorinferior) axis of rotation. A second and more applied terminology used to describe the movements that occur perpendicular to an oblique axis of rotation. Pronation describes a motion that has elements of eversion, abduction and dorsiflexion. Supination, in contrast, describes a motion that has elements of inversion, adduction and planterflexion (fig.2-2) (Neumann, 2002). Figure 2-2. Fundamental movements and applied movements of the ankle and foot. Adopted from Neumann, (2002). II. Structure and function of the joints associated with ankle: 1. Talocrural joint A. Articular structure It is also termed the tibiotalar joint or the mortise joint, and is formed by the articulation of the dome of talus, the tibial plafond, the medial malleolus and the 8

13 Literature Review lateral malleolus (fig.2-3). This joint, in isolation, behaves rather like a hinge joint that allows mainly plantarflexion and dorsiflexion (Daniel et al., 2009). Figure 2-3. An anterior view of the distal end of right tibia, fibula and talus. The articulation of three bones forms the talocrural joint. Adopted from Neumann, (2002). B. Ligaments Stability of the talocrural joint depends on both joint congruency and supporting ligamentous structures. The lateral ligaments responsible for resistance to inversion and internal rotation are the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL) and the posterior talofibular ligament (PTFL). On the other hand, the superficial and deep deltoid ligaments at the medial aspect are responsible for resistance to eversion and external rotation stress (Nordin and Frankel, 2001). Medial collateral ligament (deltoid ligament): The medial collateral ligament, also known as the deltoid ligament, It is larger than the lateral ligament and contains deep and superficial portions. The deep segment runs from tibia to talus (posterior tibiotalar). While the superficial fibers extended from tibia to navicular (tibionavicular) and calcaneus (tibiocalcaneal) (fig. 2-4) (Milner and Soames, 1998). 9

14 Literature Review Figure 2-4. Medial ligaments of the ankle region. Adopted from, Agur and Dalley (2009). The primary function of the deltoid ligament is to limit eversion across the talocrural, subtalar, and talonavicular joints. Sprains to the deltoid ligament are relatively uncommon due, in part, to the ligament's strength and to the fact that the lateral malleolus serves as a bony block against excessive eversion (Neumann, 2002). Isolated medial ankle sprains are relatively uncommon, with most deltoid injuries occurring in combination with lateral malleolus fractures or syndesmosis injuries. However, isolated injury to the deltoid ligament can occur during an eversion injury in which the body rolls over an everted foot. The anterior fibers of the deltoid are most commonly injured (Lynch, 2002). Lateral collateral ligament: The lateral collateral ligaments of the ankle include the anterior and posterior talofibular and the calcaneofibular ligaments. It originates from the anterior-inferior border of the fibula and inserts to the neck of the talus (fig. 2-5). It prevents anterior displacement and internal rotation of the talus, especially when the talocrural joint is plantarflexed (Ferran and Maffulli, 2006). So this ligament resists inversion across the talocrural and subtalar joints. The calcaniofibular and 10

15 Literature Review anterior talofibular ligaments together limit inversion throughout most of the range of dorsiflexion and planter flexion (Neumann, 2002). Figure 2-5. Lateral ligaments of ankle region. Adopted from Netter, (2006). The fibula extends further to the lateral malleolus than the tibia does to the medial malleolus. That resulted in a relative inability of the medial malleolus to adequately block the medial side of the mortise. Such body feature mainly allows larger range of inversion than eversion. So the majority of ankle sprains involve excessive inversion and subsequent injury to the ligaments and tendons on the lateral aspect of the foot and ankle including the peroneus brevis (Daniel et al., 2009). Among lateral ankle sprain injuries, 73% involved isolated rupture or tear to the anterior talofibular ligament (Woods et al., 2003).The high incidence of ATFL injury may be due the anatomical positions of its origins and insertions and its low ultimate load (Ferran and Maffuli, 2006). Burks and Morgan, (1994) reported that ATFL has the lowest ultimate load, approximately 138.9N, which is about half of that of PTFL, that is, N, and one-third of that of CFL, that is, 345.7N. These values were obtained from mechanical test on ligaments of fresh human ankles. The anterior talofibular (ATFL) ligament is stretched in a combined ankle planter flexion and subtalar supination. Common mechanisms of such an injury are landing on someone else's foot when jumping for a basketball or volleyball or tripping while descending stairs (Oatis, 2004). 11

16 Literature Review The CFL and PTFL are less commonly injured. Rupture of these ligaments typically occurs in more severe injuries, as the inversion force continues posteriorly around the ankle after the ATFL is sprained. Isolated injuries of the CFL can occur when the ligament is under maximum strain with the foot in dorsiflexion but are infrequent. Isolated injuries of the PTFL are extremely rare. Most injuries to the PTFL occur with very severe ankle sprains in which both the ATFL and CFL have been torn, and the forces continue around the lateral aspect of the ankle (Lynch, 2002). The talocrural joint possesses one degree of freedom. Motion at this joint occurs about an axis of rotation that passes through the body of the talus and through the tips of the both malleoli. Because the lateral malleolus is inferior and posterior to the medial malleolus, the axis deviates from a pure medial-lateral axis about 10 degrees in frontal plane and 6 degrees in the horizontal plane (fig. 2-6). Because of the pitch of the axis of rotation, dorsiflexion is associated with slight abduction and eversion, and planterflexion with slight adduction and inversion. The talocrural joint by definition, therefore produces a movement of pronation and supination. As a result of relatively small differences in the orientation of the axis from the pure medial-lateral, the main components of pronation and supination at the talocrural joint are, by far, dorsiflexion and planterflexion (Nordin and Frankel, 2001). Figure 2-6. Axis of rotation of the talocrural joint. Adopted from Neumann, (2002). 12

17 Literature Review During dorsiflexion, the superior surface of the talus rolls forward relative to the leg as it simultaneously slides posteriorly. The simultaneous posterior slide allows the talus to rotate forward without much anterior translation. As a general rule, any collateral ligaments that become increasingly taut upon posterior translation of the talus also become increasingly taut at full dorsiflexion. Maximal dorsiflexion elongates the posterior capsule and all tissue capable of transmitting planterflexion torque, such as the achillies tendon. During planterflexion, the superior surface of the talus rolls backward as the bone simultaneously slides anteriorly (fig. 2-7). As a general rule, any collateral ligament that becomes increasingly taut upon anterior translation of the talus also becomes increasingly taut at full planterflexion. Also, the anterior talofibular ligament and talonavicular fibers of the deltoid ligament become taut at full planterflexion (Neumann, 2002). Figure 2-7. A lateral view depicts arthrokinematics of talocrural joint during passive dorsiflexion and planterflexion. Adopted from Neumann, (2002). 2. The subtalar joint: A. Articular structure: Subtalar joint is the set of articulations formed by the posterior, middle and anterior facets of the calcaneus and talus (fig.2-8). It consists of two separate joint cavities. First, the anterior subtalar joint, or also termed the talocalcaneonavicular joint. Second, the posterior subtalar joint is formed between the inferior posterior facet of the talus and the superior posterior facet of the calcaneus (Hertel, 2000). 13

18 Literature Review Figure 2-8. Subtalar joint, anterior view. Adopted from Netter, (2006). B. Ligaments: The posterior articulation within the subtalar joint is reinforced by a set of three slender ligaments, named by location as medial, posterior, and lateral talocalcaneal ligaments. These ligaments are not usually considered primary stabilizers at the subtalar joint. The subtalar joint is stabilized by other several ligaments including, the calcaneofibular ligament and the deltoid ligament. The most substantial ligaments to cross only the subtalar joint are the interosseous (talocalcaneal) (fig. 2-9 a), and cervical ligaments (fig. 2-9 b), it provide the strongest connective tissue bond between the talus and calcaneus (Neumann, 2002). (a) Figure 2-9. Ligaments of the subtalar joint: (a) cervical ligament, (b) the interosseous (talocalcaneal) ligament,. Adopted from Oatis, (2004). 14 (b)

19 Literature Review Although considerable variation exists from one subject to another, the axis of rotation is typically described as a line that pierces the lateral-posterior heel and courses through the subtalar joint in anterior medial and superior direction. It oriented upward at an angle of 42 from the horizontal and medially 16 from the midline (fig. 2-10) (Nordin and Frankel, 2001). Figure Subtalar joint axis. A, lateral view. The axis rises up at a 42 angle from planter surface. B, Top view. The axis is oriented 16 medial to the midline of the foot. Adopted from Nordin and Frankel, (2001). The calcaneus pronates and supinates about the talus, or vice versa when the foot is planted, in a path perpendicular to the axis of rotation. Given the general pitch to the axis, only two of the three main components of pronation and supination are readily evident at the subtalar joint: inversion and eversion, and abduction and adduction. Pronation therefore, has main components of eversion and abduction; supination has main components of inversion and adduction. The calcaneus can dorsiflex and planter flex slightly relative to the talus; however this motion is small. For simplicity, the osteokinematics of the subtalar joint are demonstrated by rotating the calcaneus against a fixed and immobile talus (Neumann, 2002). The subtalar joint is responsible along with the transverse tarsal joint (consisting of talonavicular and calcaneocuboid joints) for transforming tibial rotation into forefoot supination and pronation. Because the ankle joint is to some 15

20 Literature Review degree a single-axis joint, subtalar joint reduces the rotatory stresses to the ankle joint (Oatis, 2004). The arthrokinematics at subtalar joint involve a sliding between three sets of facets, yielding a curvilinear arc of movement between the calcaneus and the talus (Neumann, 2002). Subtalar-joint sprains often occur with lateral ankleligament sprains but can occur as isolated injuries. Isolated subtalar sprains are difficult to diagnose but usually respond well to nonoperative treatment (Lynch, 2002). 3. The distal tibiofibular syndesmosis: A. Articular structure: It is formed by the articulation of the convex medial surface of the distal fibula, with the concave fibular notch of the tibia (fig. 2-11). Anatomists classify this joint as synarthrosis because it allows very slight movement and is filled with dense irregular connective tissue. The synovial membrane lining this joint is often continuous with the synovial membrane lining the talocrural joint (Neumann, 2002). Figure Antoposterior view of the distal tibiofibular joint. Adopted from, Moeller, (2000). B. Ligaments: The interosseous ligament provides the strongest bond between the distal ends of the tibia and fibula. This ligament is a distal extension of the interosseous membrane. The anterior tibiofibular ligament, the posterior tibiofibular ligament, and the transverse tibiofibular ligament (also referred to as a deep portion of the 16